Sound Advice Vol III

Another pearly email from one of the field’s fathers, and another pic that has no relation at all

A colleague saw a healthy 4 y/o with a typical viral syndrome. In the nursing triage note  one of many complaints was chest pain. The doc likely  did not read that note, or ignored it, and never addressed it in the chart. He concentrated on abdominal pain and vomiting, which were also complaints. The child seemed OK, was sent home, and died 13 hrs later of myocarditis.  Myocarditis sometimes has EKG and troponin abnormalities, but not always. They were not ordered. Not sure how this would have been different, but not addressing the chest pain will cream him on this one.

Axiom: Always read and address the nursing notes. If there was no chest pain, and he said, “contrary to nurse note, there was no chest pain on my detailed eval” or “chest pain investigated in detail and not relevant” he likely would have been better off. Imagine trying to explain this one to the parents or jury, of course everyone knows chest pain comes from the heart, dah….

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on February 19, 2012, in Sound Advice. Bookmark the permalink. Leave a comment.

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